Abstract: FR-PO1057
Understanding "Usual Care": Clinician Experiences of Symptom Assessment for Adults Treated with Haemodialysis
Session Information
- Hemodialysis: Clinical Challenges, Patient-Centered Outcomes, and Quality of Life
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Nikolovski, Jessica, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
- Smyth, Brendan, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
- Muthuramalingam, Shyamsundar, Barossa Hills Fleurieu Local Health Network, Mount Barker, South Australia, Australia
- Aiyegbusi, Olalekan Lee, Centre for Patient Reported Outcomes Research (CPROR), Department of Applied Health Sciences, School of Health Sciences, College of Medicine and Health, University of Birmingham, Birmingham, United Kingdom
- McDonald, Stephen P., University of Adelaide, Adelaide, South Australia, Australia
- Morton, Rachael L., NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
Background
Symptom burden in haemodialysis is high, yet assessment remains variable and often unsystematic. The Symptom monitoring WIth Feedback Trial (SWIFT) is Australia’s largest haemodialysis trial with an intervention of 3-monthly symptom assessment, feedback of symptom scores, and provision of evidence-based guidance for symptom management. Alongside SWIFT, we undertook a qualitative study to explore ‘usual care’ for symptom assessment, and identify approaches used for special populations, including culturally and linguistically diverse patients.
Methods
Clinicians in units enrolled in SWIFT were invited to a one-off semi-structured videoconference interview in the week before trial recruitment commenced in their unit (September 2020- July 2025). Data were analysed using inductive, reflexive thematic analysis.
Results
Forty-five clinicians (nephrologists, palliative care physicians, kidney nurses) were interviewed across 23 haemodialysis units in 4 Australian states. Overall, most clinicians asked general, open-ended questions of their haemodialysis patients such as ‘how are you going?’ followed by clinical assessments (general appearance, fluid status, blood tests), rather than specific symptom questions. Three main themes were identified. (1) Symptom monitoring was reported as futile when there were no effective treatments to manage symptoms, or when symptoms were perceived as ‘normal for age’; when allied health services were unavailable; or when patients were unable or unwilling to act on suggested management. (2) Symptom assessment rarely used patient-reported outcome measures. (3) Minimal adaptations in symptom assessment or monitoring were used for special populations (e.g., culturally and linguistically diverse populations, Indigenous peoples, or the frail elderly).
Conclusion
Symptom assessment in haemodialysis is suboptimal, unsystematic, and rarely tailored to diverse populations. Key barriers, including limited symptom management pathways, reliance on non-standardised assessment, and lack of population-specific approaches, may impede implementation of routine, systematic symptom monitoring. Clinicians would need reassurance that comprehensive, evidence-based management strategies were readily available before routine and systematic symptom assessment, monitoring, and management become standard of care for adults receiving haemodialysis.